Evaluation of nationwide variation in post-haemorrhagic ventricular dilatation management following national guideline implementation in the Netherlands

Abstract

Abstract Purpose Post-haemorrhagic ventricular dilatation (PHVD) is a severe complication of germinal matrix–intraventricular haemorrhage in preterm infants and is associated with significant morbidity and adverse neurodevelopmental outcomes. In 2023, national recommendations for PHVD management were revised, but implementation has not been evaluated. We aimed to assess diagnostic and therapeutic practices across Dutch neonatal intensive care units (NICUs), quantify inter-centre variation, and provide a basis for a national PHVD registry. Materials and methods A nationwide, cross-sectional survey was disseminated among representatives from nine Dutch NICUs and seven affiliated paediatric neurosurgical departments. Per centre, one paediatrician and paediatric neurosurgeon reported institutional practices regarding monitoring, cerebrospinal fluid (CSF) drainage thresholds, temporising interventions, permanent CSF diversion criteria, follow-up, and research priorities. Practices were compared to the Dutch guideline. Results All NICUs and neurosurgical centres responded. PHVD case volume varied (< 5 patients/year in 3/9 centres; > 20 in 1/9). Diagnostic thresholds were ventricular index > 97th percentile and anterior horn width > 6 mm in 7/9 centres, with higher or additional criteria in 2/9. Initial temporising management consisted of serial lumbar punctures and ventricular access device (VAD) placement. VAD tap duration before permanent diversion was typically 4–6 weeks (6/7). Ventriculoperitoneal shunting was the preferred permanent intervention in all centres, with weight thresholds of 2.0–2.5 kg. Conclusion Following implementation of a national guideline, PHVD management in Dutch NICUs demonstrates high consistency in core diagnostics and treatment principles, showing that national standardisation of PHVD care is feasible. Residual variation is concentrated in areas where evidence remains limited, identifying priorities for future collaborative research.